Alternative Medicines Go Mainstream

June 18, 2001 -- Americans are shelling out billions a year for alternative medicines. But more often than not, the decision to try that hot new supplement is grounded on little more than a friend's recommendation or water cooler gossip. Why? Because legitimate data have been scarce. Even doctors admit to being unfamiliar with the products and unsure of their benefits.

Let's say you're standing in the dairy aisle at your local grocery. You're concerned about your cholesterol being a bit high, and you've heard that you can actually lower it with some magical new margarines. Sounds great. But are they safe? Do they work? Which brand is best? What's the difference between the one called "Benecol" and the one called "Take Control"?

Well, check the package ingredient list and look it up! The new PDR for Nutritional Supplements provides the critical information you need to determine which, if any, of the ever-growing array of these 'functional foods,' as well as which vitamins, minerals, sports nutritional products, amino acids, probiotics, metabolites, hormones, enzymes, and cartilage products are for real and which are just a waste of money.

The nearly 600-page book gives doctors and laymen alike a complete reference source for alternative remedies. Together with the previously published PDR for Herbal Medicines, it provides a scientifically validated, trustworthy compendium of chemical formulations, indications, actions, and potential hazards of nearly every alternative medicine in use.

"There's a whole bunch of stuff out there that's not accurate and not something to rely on," principal writer and editor Sheldon Saul Hendler, MD, PhD, tells WebMD. "Particularly in the growing areas of nutritional and dietary supplementation, and functional foods, there's great need for a book that is really a critique of these products."

The new book "covers the bulk of what you'll find in a health food store, except for herbs and botanicals, which have their own PDR," says Hendler, clinical professor of medicine at the University of California, San Diego, and editor in chief of the Journal of Medicinal Food. Many items in the herbal PDR are and always have been exclusively medicinal, he explains, while "nutritional supplements include only bioactive substances found in foods that people eat somewhere in the world."

It also provides information on substances only available outside the U.S. "People travel and use the Internet, so this information is needed," says Hendler.

The entry for each substance begins with a list of common trade names and a description of its chemical structure. Next is an explanation of how the substance works in the body, along with suggested uses and whether they are legitimate. Next is a comprehensive summary of existing scientific research; a rundown of potential side effects, adverse reactions, interactions with prescription and nonprescription drugs, and foods; and finally, proper dosages where applicable.

No, it's not light reading. It's called "Physician's" Desk Reference for a reason.

But don't let that deter you, says Hendler. "The problem with most supplement books out there is that they're too simplistic, and they're wrong. It's difficult to give an accurate, precise viewpoint on a subject while keeping it too simple."

The average person should have no trouble determining whether a particular supplement is suitable and safe for his or her needs, he says. Several indexes at the front of the volume list entries by chemical name, by brand name, by recommended and purported uses, and by potential side effects.

"There are a lot of sophisticated laymen out there," he says. "They may not grasp the biochemistry and all that, but the parts on the indications and the research summaries are quite clear."

Other experts agree.

"It's clear we're in a new era where patients are taking control of their healthcare and empowering themselves," says Jeffrey Blumberg, PhD, a professor of nutrition at Tufts University in Boston, who took a look at the new book for WebMD. "It seems that this [PDR] has been written ... with the consumer in mind. It's less obtuse."

Though it may not always be the best idea, people are self-prescribing, he says, and "if they want to do it, this [book] gives them ready-to-use access to more authoritative information than simply what a neighbor tells them."

But the new PDR isn't flawless, says Blumberg.

"From the consumer's point of view, [alternative medicine] is all about what people buy at the supermarket, at GNC, at the health food store," he tells WebMD. "This reference is terrific for what it covers, but it doesn't cover it all -- and it's hairsplitting [to have separate books for herbs and dietary supplements] because consumers don't make that distinction."

Nevertheless, says Blumberg, "From the healthcare provider's point of view, [the new PDR] is handy and useful, concise, and comprehensive. Most [doctors] know relatively little about dietary supplements. They haven't been trained and often are not interested."

The result is that they often neglect to ask their patients about supplements, he says, "because they really don't know what to do with the information. Now, they can look it up and know what it is, what it does, and whether there are interactions with drugs they might want to prescribe" or other potential problems.

That was really the point of the project, says Hendler.

"I saw it as a bridge between patients and health professionals," he tells WebMD. "Typically, patients leave their physicians out of the loop regarding this whole area of nutritional supplementation because they think the physician knows little about it. And for the most part, that's true. Now, the physician has a reliable source."